- When implementing mental health and psychosocial response programs which address violence against women and girls in conflict and post-conflict settings, the type of interventions will depend on the context and emergency phase in the field. The context will determine the pre-existing knowledge and services available and how the problem is understood and responded to by the community (UNFPA, 2012). The emergency phase will determine which services are relevant and possible given priorities in the field and access issues related to security constraints. The information below should serve as a general outline, which can be adapted according the setting.
- During the Acute Response phase, mental health and psychosocial interventions for those affected by violence against women and girls should focus on:
- Basic services and security that improve general protection through the (re)establishment of security, adequate governance, and services that address basic needs in participatory, safe and socially appropriate ways.
- Community and family support level interventions could include: family tracing and reunification in instances when family reunification would be helpful for the survivor, mass communication to connect survivors to services and minimise the stigma associated with VAWG, formal and non-formal educational activities, livelihood activities and the activation of social networks, such as through women’s groups and youth clubs.
- Focused, non-specialised supports level interventions are for individual survivors who may need a mixture of emotional and livelihood support from service providers, as well as psychological first aid and basic mental health care by primary health care providers (adapted from UNFPA, 2012, pg. 86).
- During an acute emergency providing case management is usually not possible. In such settings, priorities should focus on establishing minimum essential health and psychosocial services, and it may not be possible to train caseworkers and establish a complete case management system. In emergencies characterized by the disruption and displacement of local communities and large population movements, it might also be unlikely that service providers see a survivor more than once, making follow up care unrealistic (IRC, 2012).
- Despite the challenges posed by an acute emergency setting, there are several measures that can be taken to ensure that survivors receive the critical care and information they need, and to set the groundwork for the establishment of case management services once the situation stabilizes and other essential services are in place. For example:
- Provision of training for psychosocial and medical responders addressing the principles of case management, with particular emphasis on empowering the client and informing her of her choices and services available.
- Psychosocial staff should understand all steps of case management and the principles of survivor-centered care.
- When to begin maintaining case files will depend on the specific context and your ability to ensure safe, confidential storage of all client information. As soon as a system is in place, you should introduce a basic intake tool and consent form, accompanied by a more comprehensive case management tool.
- Provision of training for psychosocial and medical responders addressing the principles of case management, with particular emphasis on empowering the client and informing her of her choices and services available.
- Where case management services existed prior to the emergency, these service providers should be consulted and should inform any tool development. While emergency responders may need to support case management service providers to cope with increased client loads, their role should be to support and reinforce the quality of services (IRC, 2012).
- During the Protracted Relief phase, mental health and psychosocial interventions for survivors and those affected by violence against women and girls should consist of all activities listed at each level in the multilevel approach for psychosocial interventions. Activities should focus on the integration of mental health services into health sector and social service structures available as well as on capacity building and support to service providers. The comprehensiveness of services may vary according to context and level of recovery efforts (UNFPA, 2012).
- During the Recovery and Rehabilitation phase interventions can focus on capacity building and support of national legal, policy and service delivery systems in order to achieve more sustainable solutions (UNFPA, 2012). For guidance, see the Health Module.
Additional Tools
Mental Health and Psychosocial Support for Conflict-Related Sexual Violence: Principles and Interventions (WHO, 2012). This is a summary of the report from a meeting on Responding to the psychosocial and mental health needs of sexual violence survivors in conflict-affected settings, organized by the World Health Organization (WHO), with United Nations Population Fund (UNFPA) and United Nations Children’s Fund (UNICEF), on behalf of United Nations Action against Sexual Violence in Conflict (UNAction), on 28–30 November 2011 in Ferney-Voltaire, France. Available in English.
GBV Emergency Response & Preparedness: Participant Handbook (IRC, 2012).
Communication Skills in Working with Survivors of Gender-based Violence, (Ward, J./Reproductive Health Response in Conflict Consortium, 2004a). The GBV Communication Skills Manual curriculum represents a collaboration between Family Health International (FHI), the RHRC Consortium, and the IRC. The manual includes a training outline, a list of materials needed, an in-depth training curriculum, and all transparencies, handouts, and activity sheets necessary to conduct a training. The training is designed so that all the materials used can be shared with participants at the end of the workshop, which will allow for subsequent trainings on topics relevant to their context. Available in English.
IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings (Inter-Agency Standing Committee (IASC), 2007). The Guidelines include a matrix, with guidance for emergency planning, actions to be taken in the early stages of an emergency and comprehensive responses needed in the recovery and rehabilitation phases. The matrix is a valuable tool for use in coordination, collaboration and advocacy efforts. It provides a framework for mapping the extent to which essential first responses are being implemented during an emergency. The Guidelines include a companion CD-ROM, which contains the full Guidelines and also resource documents in electronic format. Specific action sheets offer useful guidance on mental health and psychosocial support, and cover the following areas: Coordination, Assessment, Monitoring and Evaluation, Protection and Human Rights Standards, Human Resources, Community Mobilisation and Support, Health Services, Education, Dissemination of Information, Food Security and Nutrition, Shelter and Site Planning and Water and Sanitation. Available in Arabic,English, French, Nepali, Spanish.
Caring for Survivors Training Pack (UNICEF, 2010). The ‘Caring for Survivors’ training provides information and skills development in basic communication and engagement with sexual violence survivors in conflict-affected countries or complex emergencies. Available in English.
Psychosocial counseling and social work with clients and their families in the Somali Context: A Facilitator’s Guide (UNHCR and GRT, 2009). The handbook is designed to be used as training support handbook for helping professionals in the Somali context. The focus is on psychosocial needs for the rehabilitation of persons with trauma, mental health related forms of distress and those who have experienced gender based violence and gender related abuses. The guidelines, developed within a UNHCR funded programme in Somalia, are intended to assist staffs, who are concerned with providing protection and assistance to refugees and IDP. Available in English.
Psychosocial Care for Women in Shelter Homes (UNODC, 2011). UNODC in collaboration with the Ministry of Women and Child Development, Government of India implemented a victim support project to address the psycho-social needs of women in shelter care homes in selected states of India. In this context, UNODC in collaboration with the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore developed this manual for care givers of shelter homes. Available in English.
Violence against Women in War: Handbook for Professionals Working with Traumatized Women (Mabuse, Verlag: Suchergebnisse/Medica Mondiale, 2005). This handbook, compiled by medica mondiale, represents the first comprehensive, multidisciplinary overview of the subject of "war-related sexualised violence and trauma". The articles in it describe various working approaches which have proved valuable in working with traumatised women in areas of political crisis as well as with women refugees in countries of exile. Available for purchase.
IASC Reference Group for Mental Health and Psychosocial Support in Emergency Settings. 2012. Who is Where, When, doing What (4Ws) in Mental Health and Psychosocial Support: Manual with Activity Codes (field test-version). Geneva. This manual outlines the 4Ws with regard to mental health and psychosocial support for humanitarian actors with MHPSS coordinating responsibilities. The tool exists in two parts: a 4Ws data collection spreadsheets application (in excel online) and this manual which describes how to collect the data.
Counseling Guidelines on Domestic Violence (2001) Southern African AIDS Training Programme, Harare, Zimbabwe. This guide, developed by CIDA and the Southern Africa AIDS Training Programme is for professional and volunteer counselors and other service providers with limited counselling experience in the context of HIV. Part of a series of counselling booklets, the guidelines are based on the experience of domestic violence counsellors from Southern Africa. The guidelines cover issues including: an overview of domestic violence, its link with sexually transmitted diseases and HIV, the nature of effective counselling generally, counselling domestic violence survivors, and survivors living with AIDS, as well as a summary of the opportunities and consequences for action against domestic violence. Available in English.
The Power to Change: How to set up and run support groups for victims and survivors of domestic violence (Daphne Project 2008) (with a Portuguese translation). This manual outlines some of the practical and organisational considerations required to set up support groups for survivors of domestic violence in a way that enhances their safety and self-esteem. Available in English.
Mental Health and Psychosocial Support Network The MHPSS Network is a growing global platform for connecting people, networks and organizations, for sharing resources and for building knowledge related to mental health and psychosocial support both in emergency settings and in situations of adversity.
Additional Resources
Mollica, R., Lopes Cardozo, B., Osofsky, H., Raphael, B., Ager, A. & Salama, P. 2004. Mental health in complex emergencies. Lancet, 364: 2058–67.
The Psychosocial Working Group. 2003. Psychosocial Intervention in Complex Emergencies: A Conceptual Framework. Available in English.